Mandala (Madhya Pradesh) / Varanasi (Uttar Pradesh) / Gaya (Bihar): In July 2021, two weeks after she gave birth for the third time, Kamalwati Tumrachi sat on a charpoy, breastfeeding her infant, a cardigan and a scarf over her head, as north India sweltered.
Her village, Machhla, nestled between mountains in Mandala district 400 km southeast of MP capital Bhopal, gets chilly during the monsoons, so Kamalwati, 34, covered herself in a crimson blanket, holding her son close underneath it. Her charpoy, placed behind the door of her two-room, ensured privacy.
Kamalwati said her pregnancy was the most complicated she had.
“Until the third month, I did not know that I had conceived,” Kamalwati, a Gond Adivasi who recently converted to Christianity, told Article 14. “I thought It must be a delayed period, which I was used to because of less blood in my body.”
Kamalwati had always felt weak and had low levels of haemoglobin. “But the lockdown affected our earnings a lot, leading to limited food intake, eventually,” she said.
Kamalwati’s husband, the only earning member of the house, brought in about Rs 350 per day—below MP’s rural poverty line of Rs 408.41—working in a factory, not enough to buy nutritious food despite having access to the government’s subsidised-food system.
At the time, Kamalwati’s haemoglobin ranged between 7 and 8 gm/dL (grams per deciliter), compared to the normal 12 to 15 gm/dL for women in the first few months of pregnancy.
“I was extremely sick and on the verge of collapsing,” said Kamalwati, one of 125 million* Indian women with anaemia, now pushed to the brink as less is available during and after the pandemic-induced lockdowns and the resultant economic downturn.
A Worsening Tide Of Hunger, Anaemia
Almost 53% women between the ages of 15 and 49 are anaemic in MP, where one in three people lives below the poverty line, according to the department of social justice and empowerment.
Anaemia is often caused by nutritional deficiencies in food, particularly iron. More than half of Indian women aged 15 to 49 and children were anaemic before the pandemic, putting pregnant women at risk of producing children with mental and motor impairment, reducing their own productivity and increasing spending on ill health.
Similarly, about 189 million Indians were undernourished before the pandemic, and after a series of lockdowns, half of rural households reduced the number of daily meals and 68% reduced the number of food items in their meals, according to a May 2020 study.
As the scale of India’s unemployment and poverty crisis became apparent after the pandemic, the Supreme Court on 29 June 2021 set a month’s deadline to implement a one-nation-one-ration-card system, so that about 690 million registered for food subsidies can get such food anywhere in the country.
That still left out more than 100 million who need subsidised food but do not have the ration cards required to get it, Article 14 reported in July 2021. Even those who have ration cards may not get enough food, as indeed was the case with the Tumrachi family. They have a ration card that gets them rice and wheat but it does not give them dal and vegetables, major sources of nutrition.
“There is plenty of research available that suggests that food insecurity increased over the course of the pandemic and that the quality of diets has been affected,” Purnima Menon, PhD, senior research fellow at the International Food Policy Research Institute, told Article14. “There is also evidence that health services were affected by the lockdowns.”
“Taking these together, it is plausible that there have been impacts on anaemia among women and others but we do not know the extent of it,” said Menon.
Although the maternal mortality ratio, or the death of a woman while pregnant or within 42 days of termination of pregnancy, has reduced marginally nationwide over the past decade, in MP, it still remains 173 per 100,000 live births.
The Pandemic And Nutrition
Covid-19 further tested India’s food production and supply systems, which were already stressed due to the climate and agricultural crisis.
“As breadwinners lose jobs, fall ill or die, the food security and nutrition of millions of women and men are under threat, with those in low-income countries, particularly the most marginalized populations, which include small-scale farmers and indigenous peoples, being hardest hit,” read a WHO report published on 22 October 2020.
Kamalwati was underweight during her pregnancy. “I weighed 30 kg during the first trimester of pregnancy,” she said. “That’s when I began regular check-ups with the auxiliary nursing midwife (ANM).”
She began growing green vegetables and fruits in her backyard, the only way she could boost her nutrition, as the cost of vegetables skyrocketed. “For most of the women in our village, just rice and pej (a traditional corn drink) once a day is the only meal,” she said.
In 1,000 sq ft of land, she planted tomatoes, brinjal, bananas and a mixture of leafy climbers.
Kamalwati’s husband, Mayaram Tumrachi, formerly a mason in the southern state of Andhra Pradesh was one among about 1,14,30,968 migrant workers who had to find their way home on foot or on other unreliable transport in 2020 when Prime Minister Narendra Modi announced a nationwide lockdown without sufficient notice.
Mayaram could bring only Rs 4,000 after spending most of it to reach home.
Back in the village, Kamalwati stayed with her parents and her two pre-teen daughters managed her fields, dreaming of having three meals a day.
“I know many women in my neighbourhood who skip one meal due to insufficient quantity of food,” she said. “Most men of the house would consume pej (maize soup/ juice) as breakfast, while women would be busy cooking their first meal- lunch.”
Why More Anaemic Children Are Being Born
Sukhiya Banbasi, 22, delivered a boy in July this year. He was anaemic and underweight.
“What can I do? He is dependent on my milk and I, on rice and dal,” she said at home in the village of Musahar Tola in Varanasi district, 37 km north of UP capital Lucknow. “On good days we eat vegetables and on the best, that’s once in a month, we eat chicken.”
Children of anaemic mothers are more anaemic than non-anaemic mothers, according to the 2015-16 National Family Health Survey, the latest available data.
Women in urban areas are slightly less likely to be anaemic (51%) than those in rural areas (54%). The difference is larger for anaemia in men (25% in rural areas versus 19% in urban areas).
Banbasi’s village, populated mainly by a caste of traditional rat catchers, has around 40 women between the ages of 18-40 and none has haemoglobin levels over eight or nine gm/dL, according to the Manvadhikar Jan Nigrani Samiti (Human Rights Public Monitoring Committee), a local human rights organisation.
Statewide, almost 53% of women in UP are anaemic, which has the highest number of most backward districts out of the twenty named by Niti Aayog.
“No progress has been made towards achieving the target of reducing anaemia among women of reproductive age, with 5
1.4% of women aged 15 to 49 years now affected in India,” said the 2020 Global Nutrition Report.
Banbasi said her husband, an agricultural labourer, used to earn almost Rs 10,000 a month before the pandemic. That is Rs 102 less than the state rural poverty line of Rs 435.
“But with the lockdown, our income ceased and we eventually ran out of our savings,” she said. “I had to sell my payal (anklet) and nose-pin to get the ration for a few months, but how long could it last?”
The couple then borrowed Rs 5, 000 from a relative to buy dal and vegetables for a few months.
Banbasi married her husband Ramesh, who is eight years older, when she was 17, and they have two children. She said she had no role in deciding how many children the couple will have.
“How can I decide that? I will do whatever my husband says,” she said. The decision might also be made by her in-laws, on whose land they live.
“Earlier we would get condoms but for over a year now, we have not got any,” Banbasi said with a giggle. “This child wouldn’t have happened otherwise.”
Nirmala Devi (name changed on request), a health worker in the village, explained they were ordered to stop the distribution of condoms when the pandemic struck.
“They said we need to focus on the priorities in the times of Corona,” said Devi. “Protection is definitely not the priority right now.”
Banbasi said that health workers in her village advise her to consume more milk and fruits to ensure better lactation for her child. “But where do I get those from when one full meal a day is a blessing for us,” said Banbasi. “We even satisfy our hunger with maar-bhaat (soupy rice with salt).”
‘I Feed Myself Leftovers Most Of The Time’
Suraj Kumar, 37, is the only earning member of the family of seven; his parents, wife and three children live in Bodhgaya block of Gaya district, 100 km south of Bihar’s state capital Patna.
In March 2020, during the first lockdown, Suraj returned home when he lost his Rs 18,000-a-month job in a thread factory in Gujarat.
“He used to send 12,000 to us every month but this is one and a half years ago; now, he works as a construction worker in the town,” said Suraj’s wife, Bindiya. “He gets 350 per day but only if he gets work.”
Today, Suraj does not have enough money to take him back to Surat.
The Covid-19 pandemic shrank India’s economy by -7.3% in 2020-21, an estimated 66% of those interviewed in one survey lost jobs, the number of those living in poverty is estimated to have doubled to 134 million, more than the populations of Germany and South Korea combined, and the earnings of 230 million sank below the minimum wage.
According to the Global Nutrition Report, informal economy workers are particularly vulnerable because the majority lack social protection and access to quality health care and have lost access to productive assets.
“Without the means to earn an income during lockdowns, many are unable to feed themselves and their families. For most, no income means no food, or, at best, less food and less nutritious food,” said the report.
Bindiya was married at 16, and delivered her first child at 18. She is one of the 63% of Bihari women who are anaemic, the state having shown little to no improvement in human development indices over the last 27 years.
Bindiya’s sister-in-law died three years ago, weakened from a shortage of blood during her pregnancy. “Though she belonged to a well-off family, since her husband didn’t stay with her, she would not get sufficient food,” said Bindiya.
Bindiya was three months pregnant and had not visited any health centre or hospital when we met her in July.
She said the Accredited Social Health Activist (ASHA) came and took her to the hospital during her two previous deliveries. Not this time. No ASHA worker has come since the first lockdown was announced.
“I feel extremely weak and dizzy most of the time,” said Bindiya. “And I assume this could be because I am not eating well.”
“Women everywhere prioritise their family’s health,” said S P Jaiswar, MD, superintendent of the Queen Mary Hospital in Lucknow. “At times, we feel helpless about their life. And during this pandemic there is negligible focus on maternal health and women’s inaccessibility to health centres worsened.”
Bindiya said she felt others in the family needed more food than she did.
“My in-laws are old, children are of growing age, and my husband works hard. So isn’t it obvious that they need most of the food?” she asked. “I feed myself leftovers most of the time.”
(Jigyasa Mishra is an independent journalist who reports on public health, civil liberties and gender issues from rural India.)
The reporter reached the families in this story through PRADAN, a non-profit organisation that is supported by the IKEA Foundation (https://ikeafoundation.org/), as a part of the STaRtuP (SHG led Transformation of Rural communities through Partnership) project.
* Corrigendum: An earlier version of this story carried the wrong figure of anaemic women in India. We regret the error.